Increase Procedural Services: A Case Study

* The registrar should also be granted access to the surgeon’s office notes to review any demographic information. This will ensure consistency and identification of information that may not have been documented during the surgical check-in process.

Mandatory in-services of all pre-op and surgical team will be conducted in regards to updated processes

After consideration of public comments, CMS is finalizing their proposal to modify the MS–DRG logic for MS–DRGs 242, 243, and 244 to establish that cases reporting one ICD–10–PCS code from the list of procedure codes describing procedures

The first edition helped reassure the use of customary terms and clarifications to record procedures in the medical documents; delivered the foundation for a computer based system to assess and evaluate operational procedures; facilitated effective communication as precisely as possible for the data related to procedures and services to organizations connected with insurance claims and conveyed uncomplicated data for analyzation and statistical commitments. This first edition focused on procedures for surgeries and touched on some degree of laboratory, radiology, and prescription techniques. These restrictions encouraged the delivery of the second edition of CPT just four years later in 1970. With this subsequent publication there was a heightened

Mrs Gale is a 70 year old widow and retired unskilled worker. The patient lives alone and relies on her son to provide basic care, medication and meals. Mrs Gale has a history of weight fluctuation owing to lifestyle but is currently at risk of malnutrition due to Parkinson’s disease. Mrs Gale shows signs of early dementia and suffers from poor mobility and pain caused by arthritis. Mrs Gale also has mild depression triggered by loss and has become socially isolated. All names have been changed as per the Nursing and Midwifery Council confidentiality guidelines (2008).

Healthcare providers use Current Procedural Terminology (CPT) codes for communicating what services was rendered to the patient, to insurance companies for billing purposes. CPT category 1 codes are codes that relate to the services and procedures rendered to patient's primarily in an outpatient facility. Category 1 codes are updated yearly and are for procedures that are consistent with medical practices and procedures widely performed. Category 1 CPT codes are sectioned into six categories which include evaluation and management (EM), anesthesiology, surgery, radiation, pathology/laboratory, and medicine. CPT category 2 codes are codes that are used to communicate services rendered performance measurements and is also updated yearly.

On January 27, 2016, Elizabeth Lees stated that the U.S. Preventive Services Task Force (USPSTF) recommend for people 18 and older to get tested for depression. Taking the test will increase people health awareness as well as decrease the chances of people being depress. There is no injury for the screening so it is safe to take which means pregnant and postpartum women can take the test. Over the years they have gather quality evidence that shows the benefits of screening for depression. This screening is very accurate. So if a person is depress he or she is able to get treatment and the

An accurate and specific documentation of universally accepted set of codes are important for the protection of healthcare providers as well as increased reimbursement for services received. These codes are for the validation of which services the patient received from their health care provider ( (Page, 2009). Having the correct codes in place insures the provider with the information needed by the health insurance carrier. Maintained by the AMA (American Medical Association), this universal numeric assignment is also used for developing guidelines for medical care review as well as data collection for medical education and research (Scott, 2013).

To describe this treatment, I would use the health care common procedure coding system (HCPCS). HCPCS serve to report services provided by a physician to a patient. Together with the current procedure terminology (CPT), HCPCS became the only adequate system for reporting medical services (Giannangelo, 2010).

The second step is the major diagnostic category determination in which the principal diagnosis is assigned to an encounter for one of the 25 MDCs (Casto & Forrestal, 2015). The 3rd step is the medical/surgical determination to determine whether a procedure was performed and can be assigned a surgical status (Casto & Forrestal, 2015). The MS-DRG Definitions Manual and many of ICD codebooks verifies which procedures are valid or not valid (Casto & Forrestal, 2015). For example, minor procedures and testing do not qualify (Casto & Forrestal, 2015). Also, when a qualifying procedure is not performed, the case is assigned a medical status (Casto & Forrestal, 2015). The fourth step involves using different refinement questions to figure out the correct MS-DRG assignment (Casto & Forrestal, 2015). Therefore, once the medical and surgical classification groups for an MDC are formed, each class of patients is evaluated to determine if complications, comorbidities, the patient’s age or discharge status consistently affected the use of hospital resources (Design and Development,” n.d.).

Accurate and comprehensible medical records documents are crucial for a positive outcome for the patient and health care providers. Health records sequentially convey significant details concerning patient’s health history and future care plans. These records are pertinent when initiating care in the acute and chronic setting for the patient. Medicare, Medicaid, and other personal health care providers necessitate rational documentation to guarantee that a procedure and/or examination is consistent with the individual’s health care coverage. The documentation also authorizes the place of health care treatment, eligible medical requirement and suitability of diagnosis and/or therapy, and that the services rendered were appropriately documented. Precise and reliable medical documentation should be recorded at the time of treatment or shortly after the intervention. Inappropriate documentation can result in erroneous and inappropriate imbursement for provided health care services.

This article offers 10 suggestions on how to improve the overall quality of your health care without increasing your costs. These suggestions certainly are not a substitute for meaningful health care reform, but following these useful tips will enhance communication with your health care provider and help you get the most out of your medical coverage. 1. Read the fine print on your medical insurance policy to avoid unnecessary costs. Some health insurance policies cover preventative care, such as routine physicals and screenings, at 100% with no deductible per 12-month time period. Be aware that a 12-month time period is not the same thing as a calendar year, and keep careful track of when you had your last office visit for preventative care.

In order to understand whether this service improvement would become successful in identifying patients who need sexual health advice it would need to be implemented into a local setting, to see the impact of applying this to practise. If it was successful, it could then be expanded into other hospitals, and then nationally. This would mean that finances could be implemented safely and sensibly at first, as opposed to going nationally straight away, and the improvement failing, leading to a waste of money, resources and staff time (NHS Improvement, 2012).

Read the article Diagnosis Coding and Medical Necessity: Rules and Reimbursement by Janis Cogley located on the AHIMA Body of Knowledge (BOK) at http://www.ahima.org.

Papua New Guinea has undergone numerous government reforms with the aim of improving effective service delivery throughout the country. Since its independence in 1975 the country has achieved a lot in terms of development especially in the urban areas but not much has been achieved in the rural areas. Recently, the government has come up with the District Development Authority as a development in bringing funding closer to the people in the districts. The District Development Authority has decentralised administrative and financial powers to the district. However, there are districts that are yet to meet the minimum standards to be fully functional as a district administration. There are ongoing issues faced in the districts that needs to be made aware of the consequences that will be faced as being part of the decentralisation process.